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Psychiatry

Effects of COVID-19 on the Brain

What is the role of psychiatric research in studying COVID-19?

Can psychiatric research help the fight against COVID-19? Two recent papers address this question. In an article published in the Journal of Clinical Psychiatry , Ginger Nicol and colleagues (including one of us) discuss “repurposing psychiatry during the COVID-19 pandemic.” In an article published in Lancet Psychiatry , Emily Holmes and colleagues examine “multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.”

COVID-19 can affect the central nervous system (CNS) in addition to causing the respiratory and other symptoms described widely in the news media. Acute neurobehavioral symptoms are reported by at least a third of infected individuals and include dizziness, headaches, weakness and fatigue, muscle pain, loss of taste and smell, and impaired thinking. In addition, an increased incidence of strokes is being reported, although this may be a vascular complication rather than a direct effect of the virus on the CNS. Longer-term brain-related sequelae of COVID-19 have not yet been determined, but they are likely to occur based on long-term consequences of other coronavirus infections. With increased attention to CNS symptoms, it is likely that more neurologic and psychiatric symptoms will be documented.

It is essential to initiate neurologic and psychiatric research protocols quickly in order to determine the nature, prevalence, and course of brain-related symptoms of COVID-19. It will also be important to determine mechanisms underlying COVID-19’s influence on the brain. Does SARS-CoV-2, the virus that causes COVID-19, enter the CNS? Do effects of the virus on other parts of the body influence brain function indirectly? Once the mechanisms of brain dysfunction are determined, can treatments be designed to stop these effects on the brain? If there are longer-term CNS sequelae, can the mechanisms of these effects be determined and prevented?

In addition, there are psychiatric symptoms that are not directly related to the virus, but to the consequences of the pandemic itself. How prevalent will symptoms of post-traumatic stress disorder be among frontline healthcare professionals? How much of an upsurge in anxiety disorders, depression, and substance use disorders will occur as a consequence of psychosocial stress, ongoing fear, social isolation, bereavement, job loss, financial insecurity, and loss of purpose? Will suicide rates increase? Documenting the nature and prevalence of psychiatric consequences of the pandemic and developing treatment strategies will be essential.

Psychiatric expertise will also be valuable when designing treatments for COVID-19. Some psychiatric drugs have properties that have potential for diminishing some of the acute harm caused by the virus. For example, the antidepressant fluvoxamine has anti-inflammatory properties. This drug is currently being tested to see if it might prevent some COVID-19 symptoms resulting from an infection-related surge in inflammatory chemicals. Repurposing commonly prescribed medications requires carefully designed clinical trials.

Many academic psychiatrists are knowledgeable in the proper design of such trials. Some are also experienced in conducting such trials on virtual platforms and can advise other physicians on how to administer drug trials remotely. Virtual trials will be particularly important when working with study participants who have early symptoms of COVID-19 and are quarantined, and are only able to participate in treatment trials from home.

The COVID-19 pandemic requires a swift response from our research and treatment development enterprise. Psychiatric researchers have much to offer with respect to the design and implementation of clinically relevant studies.

This article was written by Eugene Rubin MD, PhD and Charles Zorumski MD.

References

Nicol, G.E., Karp, J.F., Reiersen, A.M., Zorumski, C.F., & Lenze, E.J. (2020 Apr 7). "What were you before the war?" Repurposing psychiatry during the COVID-19 pandemic. J Clin Psychiatry. 81(3). pii: 20com13373. doi: 10.4088/JCP.20com13373.

Holmes, E.A., O'Connor, R.C., Perry, V.H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., et al. (2020 Apr 15). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. pii: S2215-0366(20)30168-1. doi: 10.1016/S2215-0366(20)30168-1. [Epub ahead of print]

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